Examining the Effect of Sleep Disruption on Emotion Regulation and Trauma-Related Symptoms in Veterans

检查睡眠中断对退伍军人情绪调节和创伤相关症状的影响

• 批准号: 9888960
• 负责人: Laura D Straus
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9888960
• 关键词: Acute; Affective; Biological Process; Clinical; Cohort Studies; Cross-Sectional Studies; Data Reporting; Development; Diagnostic; Disease; Distress; Emotional; Emotions; Evidence based treatment; Goals; Gold; Image; Impaired cognition; Impairment; International; Intervention; Laboratories; Link; Literature; Longitudinal Studies; Maintenance; Measures; Mental Health; Methods; Modeling; Nightmare; Participant; Patient Self-Report; Patients; Pharmacology; Post-Traumatic Stress Disorders; Process; Questionnaires; REM Sleep; REM Sleep Deprivations; Randomized; Recording of previous events; Reporting; Research; Research Personnel; Risk Factors; Role; Sampling; Severities; Sleep; Sleep Deprivation; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Sleeplessness; Slow-Wave Sleep; Stimulus; Symptoms; System; Testing; Time; Training; Trauma; Validation; Veterans; active control; base; career; cognitive reappraisal; cohort; design; effective intervention; emotion regulation; evidence base; experimental study; imaging system; indexing; longitudinal analysis; modifiable risk; physical conditioning; post-traumatic symptoms; psychosocial; recruit; response; sleep quality; sleep regulation; trauma exposure

Posttraumatic Stress Disorder (PTSD) is common in Veterans and associated with a number of negative physical and mental health consequences. While evidence-based pharmacological and psychosocial interventions for PTSD have been developed, not all patients respond fully to treatment. Investigating the biological processes involved in the development and maintenance of PTSD will increase understanding of the disorder and aid in the development of more effective interventions. Sleep disruption, particularly Rapid Eye Movement (REM) sleep disruption, is a potent and modifiable risk factor contributing to PTSD. For example, longitudinal studies have shown REM sleep fragmentation in the acute aftermath of trauma predicts PTSD symptoms at a later timepoint, underscoring the potential importance of sleep as a mechanism in PTSD. Recent research has also demonstrated an association between poor sleep and impaired emotion regulation. Specifically, research suggests disrupted sleep impairs effective emotion regulation strategies, such as cognitive reappraisal, while increasing reliance on more maladaptive emotion regulation strategies, such as expressive suppression. For example, previous studies have shown poor sleep at baseline predicts impaired cognitive reappraisal in lab-based tasks involving emotionally provocative stimuli. Our research group has also demonstrated that poor self-reported global sleep quality is associated with reduced cognitive reappraisal and increased reliance on expressive suppression when measured at one timepoint in a large group of Veterans with and without PTSD. The implications of this finding are particularly salient for patients with PTSD, because maladaptive emotion regulation contributes to severity of trauma-related symptoms, increases distress, and interferes with gold-standard interventions for PTSD. However, most research linking disrupted sleep to impaired emotion regulation has been conducted in healthy controls, or at only one time-point in clinical samples. Therefore, additional research is necessary to provide support for a hypothesized model whereby disrupted sleep contributes to maladaptive emotion regulation, thus in turn maintaining trauma-related symptoms. This study responds to these gaps in the literature by using both self-report longitudinal measures and an experimental sleep manipulation to test the hypothesis that disrupted sleep contributes to maladaptive emotion regulation in Veterans with and without PTSD. The first aim of the study will be to examine whether poor sleep at one timepoint predicts maladaptive emotion regulation and trauma-related symptoms at subsequent timepoints in a large cohort of Veterans with and without PTSD. The Insomnia Severity Index (ISI), the Emotion Regulation Questionnaire (ERQ), and the PTSD Checklist (PCL) will be measured at three timepoints in this cohort. We hypothesize that poor sleep at the first timepoint will predict reduced reappraisal, increased expressive suppression, and increased severity of trauma-related symptoms at the subsequent timepoints. The second portion of the proposed project will build upon these findings by experimentally testing the notion that disrupted sleep results in impaired emotion regulation, and will also directly test the hypothesis that REM sleep specifically is tied to emotion regulation processes. A sample of Veterans (n = 60) with and without PTSD will be recruited and randomized to undergo one of three sleep conditions: 1) one night of REM sleep deprivation (REMD), 2) one night of slow-wave sleep deprivation (SWSD, an active control condition), or 3) one night of normal sleep. Participants will then participate in two laboratory emotion reappraisal tasks using images from the International Affective Picture System (IAPS). We hypothesize that participants in the REMD group will rate the images more negatively during a cognitive reappraisal task than SWSD group or the normal sleep group, and will also be more likely to choose expressive suppression than reappraisal on an emotion regulation choice task. Exploratory analyses will determine if this effect differs by diagnostic group status.

创伤后应激障碍（PTSD）在退伍军人中很常见，并与许多负面因素有关。 身心健康后果。虽然循证药理学和心理社会学 虽然PTSD的干预措施已经开发出来，但并非所有患者对治疗都有完全反应。调查 参与PTSD发展和维持的生物学过程将增加对PTSD的理解。 并协助制定更有效的干预措施。睡眠障碍，特别是快速眼 运动（REM）睡眠中断是导致PTSD的一个有效和可改变的风险因素。比如说， 纵向研究表明，创伤后急性期的快速眼动睡眠片段可预测PTSD 在稍后的时间点出现症状，强调睡眠作为PTSD机制的潜在重要性。 最近的研究也表明了睡眠不好和情绪调节受损之间的联系。 具体来说，研究表明，睡眠中断会损害有效的情绪调节策略，如 认知重新评价，同时越来越依赖于更不适应的情绪调节策略，如 表达抑制例如，以前的研究表明，基线睡眠不好预示着 在涉及情绪刺激的实验室任务中的认知重新评估。我们的研究小组还 研究表明，自我报告的整体睡眠质量差与认知重新评估减少有关， 当在一个时间点测量时，在一大群退伍军人中对表达抑制的依赖增加 有没有创伤后应激障碍这一发现对PTSD患者的影响尤其突出，因为 适应不良的情绪调节导致创伤相关症状的严重程度，增加痛苦， 干扰了创伤后应激障碍的黄金标准干预措施。然而，大多数研究都将睡眠中断与 在健康对照组中进行了情绪调节受损，或者在临床试验中仅在一个时间点进行了情绪调节受损。 样品因此，有必要进行更多的研究，为假设模型提供支持， 中断的睡眠有助于适应不良的情绪调节，从而反过来维持创伤相关的 症状本研究通过使用自我报告纵向测量来回应文献中的这些空白 以及一项实验性的睡眠操作，以检验睡眠中断会导致适应不良的假设。 有和没有创伤后应激障碍的退伍军人的情绪调节这项研究的第一个目的将是审查是否 在一个时间点睡眠不好预测适应不良的情绪调节和创伤相关症状， 随后的时间点，在一个大型队列的退伍军人与非创伤后应激障碍。Increased Severity Index（ISI）， 情绪调节问卷（ERQ）和PTSD检查表（PCL）将在三个月内进行测量。 在这个时间点上。我们假设，在第一时间点睡眠不好将预示着减少重新评估， 表达抑制增加，随后创伤相关症状的严重程度增加 时间点。拟议项目的第二部分将通过实验测试建立在这些发现的基础上 睡眠中断会导致情绪调节受损，这一观点也将直接检验这一假设。 快速眼动睡眠与情绪调节过程密切相关。退伍军人样本（n = 60）， 没有PTSD的人将被招募并随机接受三种睡眠条件之一：1）一晚的REM 睡眠剥夺（REMD），2）一晚的慢波睡眠剥夺（SWSD，一种主动控制条件），或 3)一夜正常睡眠。然后，参与者将参加两个实验室情绪重新评估任务， 国际情感图片系统（IAPS）我们假设参与REMD的人 在认知再评价任务中，SWSD组对图像的评价比SWSD组或正常组更消极 睡眠组，也更有可能选择表达抑制，而不是重新评估情绪 规则选择任务。探索性分析将确定这种影响是否因诊断组状态而异。